Putting it to the test Along with romance, an HIV awareness

THE BALTIMORE SUN

As the AIDS epidemic continues to spread, being tested for the human immunodeficiency virus that causes the disease has become an increasingly common rite of passage in modern relationships.

"I think now, my God, that was stupid," Kevin says of an affair he began with a woman several years ago before either was tested. "We were already into it -- it was a whirlwind thing -- when she brought it up."

They went together for HIV tests.

So did Heidi and her lover, Juliet. "We made it like a date," Heidi recalls. "We went to lunch before, and then we went to a movie after."

The middle part of the "date" was a trip to a clinic for an HIV test.

While both couples tested negative, the specter of acquired immune deficiency syndrome forced them to confront issues such as HIV status, the use of condoms and their sexual and drug-use histories. That's heady discussion matter for those in long-term relationships, much less couples just getting together.

It's difficult to know how many people are taking HIV tests today. Only publicly funded testing programs report their statistics, whilethe majority of tests are believed performed in private physicians' offices, clinics and HMOs. But health professionals believe the number is on the upswing as AIDS awareness grows.

"More people are getting tested these days," says Dr. Alfred Saah, an epidemiologist with the Johns Hopkins School of Public Health, who has been working with National Basketball Association players in the aftermath of Magic Johnson's revelation that he is HIV-positive. "More and more physicians are recommending that their patients be tested, and people are becoming much less afraid of getting tested."

For some, AIDS has forced a new sense of responsibility in dating. Some singles say the threat of the disease has made them less likely to engage in casual sex.

"I do not want to be part of the transmission of this virus," says Scott, who has been tested twice, once before he was married and then again following a post-divorce bout of "promiscuity."

"I am sort of seeing several different people now, but the physicality definitely has its limits," the 27-year-old says. "It's terribly interesting, after having been through the laissez-faire of the late '70s and early '80s, to now have this to deal with. It's been an adjustment, but I'm finding it enjoyable to relate to people on a different level. If you're going to be more involved today, it entails more of a commitment. Sex -- that can wait."

But Scott (whose last name, like that of the other singles interviewed for the story, has been omitted) says he's found that heterosexuals seem less conscientious about testing than gays he knows.

Dr. Saah and other AIDS specialists agree. They say gays, the first group to contract the disease in large numbers, are several years ahead in their awareness of the need to be tested as well as how to avoid acquiring or transmitting HIV.

"Look at the teen-age pregnancy rate . . . If kids are out there getting pregnant, they're obviously not using condoms," Dr. Saah says. "We're not seeing dramatic drops in sexually transmitted diseases [among heterosexuals], which was one of the first things we saw in gay men after they started getting the message about AIDS."

Heidi, 28, who is a lesbian, had been seeing her partner for about a month when they made their "date" to be tested, mainly because her partner previously had been involved with a man who used intravenous drugs.

"Having an HIV test really sets you up for monogamy, for settling down with one person. I'm ready for that," says Heidi, who lives with her partner in East Baltimore. "I love my life a lot, I love my family. I've watched a great deal of my gay friends die from AIDS."

Kevin admits he hasn't always had protected sex in the past, although he's been increasingly careful in recent years.

"I have to think about this now," he says. "I'm not crazy. I want to live."

Ariana, 23, gets tested during regular physicals or exams even though she's been living with her boyfriend for about two years. She was more concerned about her HIV status than her boyfriend's when they first became involved.

"He's younger, and not as sexually active as I had been in the past she says of her 21-year-old boyfriend. "If he had been older, if I'd known he played the field, I would have been more concerned."

While she says the two of them felt fairly comfortable broaching the subject of HIV testing -- Ariana says they both come from families in the Foreign Service and thus routinely have been "poked and tested for all sorts of exotic diseases" -- that's not always the case with newly involved couples. Often, the problem is as much when as how to bring up the delicate matter.

"At the dinner table during the first date is probably premature. But if you're already under the covers and your clothes are off, it's probably too late," says Martha Bonds, an HIV counselor with the Baltimore County Health Department.

Health professionals recommend that couples discuss HIV status before engaging in sexual activity. For those who already know that theyare positive, though, this puts them at risk of immediate rejection.

"We counsel them to bring it up right away if it's a new relationship, before they become too emotionally involved," says Joe Jacques, an adult educator with HERO, an AIDS resource group in Baltimore. "It's a difficult decision. Some people who are HIV positive have lost friends and family. But we still advise them to divulge their status [to potential lovers]."

This fear of losing loved ones, or squelching the prospect of a romance, prevents some people from being tested, Dr. Jacques says. "There are many people who should be tested and are not," he says. "They're afraid because they think they can't handle it psychologically. Or, if they discover they are positive, they'll have social problems."

Dr. Jacques encourages counseling as part of the HIV testing process -- and, indeed, most facilities offer both pre- and post-test counseling.

"We talk about why the student wants to be tested," says Marilyn Gall, clinic nursing administrator for the student health clinic at the Johns Hopkins University, which has seen an increase in the number of requests for HIV testing. "Have they thought, for example, about how the result -- either positive or negative -- will affect the rest of their life? Have they discussed it with their partner?"

Ms. Gall says students ask to be tested for several reasons. "A lot think it's the responsible thing to do when they are about to engage in a new sexual relationship," she says. "Or, sometimes you'll see them at the end of a relationship, when they are not sure their partner has been monogamous.

"Other times, it's because they've had a one-night stand, or started engaging in a new sexual practice. Or, they need the test to get a visa, or they're applying for life insurance or health insurance."

Also, staff members explain the meaning of the results: "A negative result means three months ago you were negative; this doesn't mean you'll be negative forever," she says. "We try to make them aware, this is only their side of it. They have to #F consider their partner's HIV status."

Finally, there is the emotional side of the counseling, she says. "The test and the sexual act itself is important, but relationship implications are significant, too," she says. "We try to encourage them to have monogamous relationships."

Ms. Gall is heartened by what she sees as responsible behavior among the students.

"I am not seeing a pattern of repeaters -- students who are re-engaging in risky behavior," she says. "There will always be that population that should be tested but is not, that doesn't want to deal with the reality of it or don't realize that their behavior is risky. But our students seem very responsible."

"It is not who you are...

In the early days of the AIDS epidemic, people used to talk about "risk groups --gay men,intravenous drug users and hemophiliacs, for example. Today, however, the emphasis is on your behavior, rather than the group you belong to.

It is not who you are,its what you do," says Irwin Rothenberg, director of education for HERO, a Baltimore AIDS resource group. "The concept of risk groups allowed people to cop out."

Deciding whether you should be tested for HIV involves determining whether you or your partner engage in risky behavior, such as:

* Having unprotected intercourse without a condom, whether by heterosexuals or homosexuals. Oral sex is also a risk, although a lesser one. And condom failures should be taken into account.

* Sharing needles, such as for intravenous drug use. (But, Mr. Rothenberg adds, people may have shared needles in piercing ears, tattooing or steroid use.)

If you or your sexual partner has engaged in such behavior in the past 12 years, you should consider getting tested, he says.

Honest communication is obviously needed in the matter: "Monogamy means both partners are monogamous," Mr. Rothenberg says. "The question people have to ask is whether they can trust what their partner says. Some people will say anything to get a person in bed."

Also, a test is merely a reflection of the person's status at the time of testing. If your partner claims to have tested negative some time ago, that's no assurance he or she is still in the clear.

Most testing facilities offer pre-test counseling to further help you determine if you should be tested.

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